Team-based Education Helps Fulfill PCMH Promise

Residents, Students, Educators Embrace Interprofessional Training

What's the best way to bring a good idea to fruition? Make sure people know about it. That's exactly what the Patient-Centered Primary Care Collaborative (PCPCC) did last year when it launched an interactive database(www.pcpcc.org) that features academic and training institutions that have embraced interprofessional training that brings together medical students, residents, clinicians and other health care professionals.

"We are delighted to have laid the foundation for a valuable resource that will help health professionals, academics and students understand and evaluate training programs around the country and their focus on patient-centered, collaborative team-based care," said Bill Warning, M.D., co-chair of the PCPCC's education and training task force, in the Dec. 13 press release announcing the launch.

Fast forward to today and a conversation Warning recently had with AAFP News about this popular resource and why it was created.

Story Highlights

Interprofessional training is increasingly being used as an educational model in U.S. medical schools and residency programs.

Working alongside other health care professionals allows medical students and residents to understand and appreciate others' skills sets.

Students and residents exposed to interprofessional training support the concept and look forward to providing team-based care in practice.

"Nothing like this database existed," said Warning. "And rather than a static publication, we wanted a resource center that people could go to and upload curriculum and share documents both regionally and nationally." And so they have -- to the tune of more than 100 programs currently.

One word of advice: Last year's database launch was greeted with such an onslaught of submissions that the PCPCC technology team had to shut the system down temporarily to catch up. To avoid the same problem this time around, institutions have until March 31 to submit materials to have their programs included.

According to Stan Kozakowski, M.D., director of the AAFP Division of Medical Education, the Academy supports the concept of training interprofessional health care teams and applauds the new PCPCC database.

"The AAFP recognizes that high-functioning interprofessional teams are one of the cornerstones of the patient-centered medical home (PCMH)," Kozakowski told AAFP News. "Like any effective team, the members of the PCMH team will be most effective when they train together and learn from one another."

Ohio Family Physician Pushes Legislation

Having run a family medicine residency program for 22 years before serving a stint as head of Ohio's Department of Health, Wymyslo readily recognized the value of interprofessional training and was a staunch supporter of H.B. 198, which put together a formula to build and fund a project aimed at training primary care physicians to create PCMH practices.

AAFP Resources

The AAFP has resources on team-based care and the patient-centered medical home, including

Interprofessional education and curriculum reform also were important components of that legislation.

In a recent interview, Wymyslo defined interprofessional training this way: "For me, it just means in the health professional training sector, that people who have shared interest in and responsibility for patient care should train with each other collaboratively to achieve better outcomes."

In other words, he noted, interprofessional training offers "a preamble to doing team care in practice."

"It's really hard for clinicians to enter practice knowing how to work in teams unless they've had prior exposure to each other," said Wymyslo. "They need to be able see the values and benefits everyone brings to the table when they jointly try to achieve health and wellness for their patients."

Sure, team-based care can be learned on the job, Wymyslo acknowledged. "But why have me spend 10 years in practice figuring out how to do this when I could train in an environment that shows me how to do this, so that on day one starting in practice, my patients get the benefit of team care?"

With team-based care, he added, "We can stretch our doctors in ways never before seen so they don't have to be everything to everyone."

Team-based Training in Action

Interprofessional training is becoming a reality at Ohio State University College of Medicine in Columbus. Just ask Holly Cronau, M.D., an associate professor of clinical family medicine at the college, where all the associated medical clinics have attained level-three PCMH recognition from the National Committee for Quality Assurance.

"Students who are in our clinics and our affiliated residency programs are spending time with pharmacists, dieticians and social workers, and we'll add physical therapy and occupational therapy to our didactics in the next academic year," said Cronau. This type of training, "allows students to see how those professionals receive consults from the physicians, interact with our patients and observe how the whole team works together."

"Our students will be heavily involved in team-based care when they come back for their advanced clinicals in the fourth year," Cronau added.

And the reaction of medical students to this kind of learning?

Cronau said the most telling remarks have come from students who've just returned from rotations at some of the more remote clinics that haven't yet been able to accomplish team-based training. Questions such as, "What did you see?" and, "What did you get to experience?" are common, she said.

Warning, who also serves as program director of the Crozer-Keystone Health System Family Medicine Residency Program in Springfield, Pa., related the same positive feedback from his residents.

"They say they can't imagine doing their job without the resources of the team," said Warning. For some newly minted family physicians, the team-based care they've grown to appreciate in residency training has been hard to find in practice.

"I'm producing a product right now, a graduate of three years of family medicine residency training, who is demanding services that a lot of practices honestly can't supply because they do not have the luxury of having interprofessional people on their staffs," said Warning.

Wave of the Future

John McCarthy, M.D., a family physician and assistant dean for regional affairs at the University of Washington School of Medicine in Spokane, said the Spokane campus has been teaching medical and dental students together, allowing each set of students to gain respect for and understanding of the other's skills set.

According to McCarthy, it helped that it was a new campus, just five years old, with progressive leadership. "We were able to think about what we wanted to start with and everybody agreed that we wanted to begin with team-based learning when possible," he said.

In fact, very recently, the school received a grant to establish a teaching health center. "We're talking about building a multidisciplinary clinic with speech, physical therapy, physician assistants, nurse practitioners, physicians and dental," said McCarthy.

McCarthy also works in a residency program where team-based care is second nature. "We work in those teams; we live in those teams. And we honor and appreciate the skills and talents that each of us in that team bring to the table." He said the clinic doesn't hesitate to bring in a pediatrician, an orthopedic specialist or even a podiatrist when necessary.

Bottom line, said McCarthy, "When you work as a team, you simply provide better care; there is no question about it."